Can you tell how each of the endocrine glands relate to the problem of obesity?
The pituitary is a tiny gland situated at the base of the brain. It is fashioned of three lobes, but it weighs only a little more than an aspirin tablet. The pituitary is, among other things, the supervisor of hormone production in your body. It produces hormones which work on other glands, such as the thyroid and the sex glands. It also produces two hormones which directly affect the manner in which the system utilizes fat.

One of these pituitary hormones promotes the deposition of fat in the fat cells. The other stimulates the release of fat from cells. When you produce these hormones in proper amounts, your body’s equilibrium is more likely to be maintained. When you produce these hormones in quantities that do not match, there will be trouble, probably in the shape of obesity.

Most obese people have no pituitary disturbance, but it is important to know that for some, however few, pituitary disturbance may be the cause of obesity.

What effect can a very underactive thyroid gland have on an adult?
The thyroid gland is located in the neck directly in front of the windpipe. Under the control of the pituitary, it secretes a hormone called thyroxin which is rich in iodine and which helps the body burn up fat. If your thyroid is particularly active you reduce fat to water and carbon dioxide much more quickly. If the thyroid is inactive, the fat turnover is slowed down. Since less fat is burnt, more fat is stored. An underactive thyroid gland can and does cause excessive weight gain, but only about 2 to 3 percent of overweight and obese patients can blame a sluggish thyroid gland for causing their problems. Once in a while physicians find patients whose overweight problem is caused by an underactive thyroid, functioning at greatly reduced levels. When this happens the patient experiences more aramatic symptoms than a mere gain in weight. The case of G. M. a twenty-five-year-old woman, is a perfect example of this situation.

Three years prior to her diagnostic examination she began to develop physical weakness and lethargy, her speech slowed down and her menstrual periods became irregular. She also complained of falling hair. Nine months before I examined her, she developed a remarkable sensitivity to cold and perspiration decreased. Upon examination, she was found to have dry, coarse, pale skin, dry brittle hair, sparse eyelashes and eyebrows, her tongue was enlarged, her lips swollen, her speech thick, and her thyroid gland noticeably enlarged. These symptoms are typical of low thyroid. Her metabolism was shown to be excessively low and her blood chemistry revealed a deficiency of the thyroid hormone. In addition, she was 12 kilos over her ideal weight.

G.M. was diagnosed as a case of adult myxoedema - a medical term for an advanced case of a deficiency of thyroid hormone. IN such a case, thyroid hormone is given to the patient along with a special nutritional food programme. Within three months, G.M. felt considerably better. Soon her metabolism and thyroid hormone levels returned to normal. She has now maintained her weight loss for three years. She will have to continue her thyroid medication for the rest of her life.

What effect can a very underactive thyroid gland have on a child?
You have just read of a case of an adult woman with what is called adult myxoedema. A grossly underactive thyroid gland can also occur in the young , it is then referred to as juvenile myxoedema. S.K. was a thirteen-year-old healthy body. Suddenly, he became sluggish and withdrawn and put on ten kilos. He was brought to me for a weight problem. As in the case of his adult counterpart, the laboratory tests showed that he was deficient in the thyroid hormone. He was given the proper amount of thyroid medication to bring his abnormal levels to normal, and at the same time was placed on a well- balanced food programme to remove the excess ten kilos. This type of thyroid deficiency or juvenile myxoedema can be the result of a virus infection, or its origin may also be genetic.

How is my pancreas related to obesity?
The pancreas, is located at the back of the stomach. The main function of pancreas is the secretion of insulin, a substance which is vital in the control of fat formation. Among other thing, insulin speeds up the body’s transformation of carbohydrate into fat. It also works on the storing of this fat and inhibits the release of fat already stored. Obese persons, as a group, tend to have an over responsive pancreas gland and produce excessive quantities of insulin. When they eat a certain amount of carbohydrate, they get a higher rise in insulin than a person who is not obese, leading to the formation of and storage of fat in the body.

My aunt who is overweight says that she has now reached a stage where just looking at food makes her fat? Is this not ludicrous doctor?
The notion that just looking at food can make some people gain weight may sound ludicrous, but it is closer to the truth than you may think. This was demonstrated at Yale University, where psychologist Judith Rodin measured the reactions in a group of former fat people to a thick juicy steak sizzling on a grill in front of them. It was to be their reward after an 18 hour fast. Dr.Rodin took blood samples as they watched the steak cooking. "Those who were highly responsive to the steak cooking before them also had high levels of insulin release from the pancreas gland." Dr. Rodin says, "Being turned on just by the sight of food set their metabolic process in motion. Insulin accelerates the intake of fat into the cells as we have just read. So the more insulin that is secreted, the faster the fat will be stored."

In short, those who drooled over the steak turned more of it into fat than those who didn’t. "We think that 60% to 70% of the people who are moderately overweight are like this", says Dr. Rodin.

What are the adrenal glands?
The adrenals are two peanut-sized glands just above the kidneys which produce atleast twenty important body substances, including cortisone.
Overactive adrenal glands cause a disease called Cushing’s Syndrome, which creates a unique pattern of fat. A victim of Cushing’s Syndrome puts on excessive fat over the spine, the upper chest, the hips, and most notably the cheeks. The first thing you notice about someone suffering from Cushing’s Syndrome are jowls. They sag under the burden of a large quantity of extra fat. Even when a victim of a Cushing’s Syndrome becomes generally emaciated, he retains much of his fat in the characteristic places. This is a case of pure glandular obesity. But fortunately this disease is rare.

Does too much or too less of a hormone cause obesity or is it the other way round?
Let me explain this with an example.
When certain people are under tension, their system puts out more of an adrenal gland secretion called hydrocortisone which tends to increase the appetite. These people are stresseaters. They feel better when they eat. This leads to overindulgence of food. Result, Obesity.

On the other hand, if a person is overweight, this might alter his body’s metabolism, so that the adrenal glands tend to be over responsive in stress situations leading, to increase in appetite, overindulgence of food and resultant obesity. But the question is, what has led to obesity ? Has increased amount of hydrocortisone caused obesity or has obesity caused increase in secretion of hydrocortisone? In short, it is difficult to say, "Which is the cart and which is the horse?" with regard to over weight and obese individuals.

Every class of food has its own specially designed reception in the body and each has a special metabolism. Fat metabolism includes a teamwork by the liver, the pancreas, the intestines, the lymph glands and endocrine glands such as the thyroid, pituitary and the ovaries.
When a person puts on too much weight and overworks the fat regulating functions, the metabolism may become abnormal. The glands involved go out of order. Yes, there’s no doubt that,in time, most obese persons develop some glandular type of fat. Yes it is extremely important to understand that when the obese person, through normal well-balanced nutritional food returns to his ideal weight, his excretion and production of hormones returns to normal.

What will happen to a boy if he does not produce enough sex hormones?
Lack of sex hormones is also related to obesity. Take the case of A.S., a sixteen-year-old-boy who was eleven kilos over weight and had excessively underdeveloped sexual organs.

After gong through his medical history and performing proper physical examination during a diagnostic consultation visit, I noted that he had a significantly increased eating pattern. Laboratory tests showed that A.S.’s basic metabolic rate was low as was his secretion of adrenal hormone. It was shown that the boy had what is known as Frohlich’s Syndrome. This is a condition characterised by obesity and under development of the sexual organs due to lack of sex hormones.
The boy was treated with specific hormones necessary to stimulate sexual development. He was also placed on a nutritionally well-balanced food programme. At the end of four months, there was a significant growth of the sex glands and by the end of the year they were normal. He also had reached his ideal weight. This is one clear-cut case of obesity directly related to an endocrine or glandular obesity.

What about the role of sex glands in adults?
The sex glands in adults also have some role to play in obesity, particularly in governing the distribution of fat. We know that while a man acquires fat at the back of his neck and his waist, a woman tends to acquire it on the buttocks and on the thighs, if a man suffer s from a disease or undergoes an accident necessitating the removal of his testicles, his fat distribution will become feminine ; that is he will put on fat on the buttocks and on the thighs. He will also be likely to put on more over-all fat. A woman whose ovaries have been removed similarly tends to become fat. The sex glands in adults have a role in a small minority of obesity cases.

I am twenty-five-years-old and my husband is twenty-eight-years-old. It’s been 3 years since we’ve been married and are very anxious to have a baby. After a thorough medical examination and laboratory tests on my husband and me, my gynaecologist is of the opinion that we are both normal and that we require no other treatment for our problem of sterility but to lose weight as we are both suffering from obesity. Doctor kindly explain.
Obesity tends to alter the sex hormonal ratio. In obese women, an alteration in the Sex Hormone Binding Globulin (SHBG) which is a protein that helps transport the sex hormone through the body brings about an imbalance in the male and female hormone levels. The resulting increase in the level of testosterone (the male hormone) in the blood leads to hirsuitism (excessive hairiness on face, arms and legs) and also ovulatory disturbances such as irregular periods. In some cases, ovulation may be absent, resulting in infertility.
In obese men, excess fat may not only cause hormonal imbalance but also hamper sperm production and thus impair fertility. When an overweight man or woman seeks medical help for infertility, in addition to the other lines of treatment, doctors usually advise them first to lose weight.

Is it common for a woman to gain weight after menopause?
Weight gain in women following menopause is not uncommon and very often is just accepted as a fact of life by the victim. In many cases, the condition goes untreated, and the unfortunate woman remains fat and very often shows certain personality changes which are irritating not only to her, but to her family and friends as well.

Mrs. M.R. was forty-three-years-old and weighed thirty-three kilos over her ideal weight. Till she reached menopause, she had no trouble maintaining her weight and had lived her life full of pep, vigor and a cheerful disposition. During her menopause, she began to experience hot flushes, extreme fatigue, headaches, and spells of irritability. In addition, she began to steadily gain weight. She also developed pain in her lower back and in areas above her knees.

After going through her history , a thorough physical; examination and laboratory tests, I diagnosed the real cause of her obesity. Her body was not producing enough female hormones. This is a very common occurrence, and with proper treatment and a well-balanced nutritional programme her problems,resulting from a scarcity of female hormones, were completely reversed. Within eighteen months she had regained her desired weight of fifty-five kilos. Her other symptoms vanished, and the pain from her osteoarthritis disappeared as the additional weight on her back and her knee-joints reduced. Her disposition became sunny again. She regained her former vigor, and the frequent headaches ceased. She has maintained her desired weight for four years now.

I feel bloated and gain weight just before my period. What can I do about this? Is it glandular?
Yours is a case of fluid retention which in cases of obesity is a fairly common occurrence. Fluid retention in women ten days prior to the beginning of a menstrual period is also very common. Most women complain of feeling bloated just prior to their menstrual period. The weight gain in any one given month may range from 1 kilo to as much as 3 to 5 kilos. Very often, simply limiting the amount of salt in the diet will alleviate the problem and the discomfort caused by it.

Since I went on the birth control pill, I have gained weight. Why? What should I do to lose it?
Yes, it is true that many women find it hard to keep their weight down when they are on the pill.
Not surprisingly really, if you consider how the pill works - it makes the body think it is pregnant.
The pill contains the major hormone responsible for the changes occurring in pregnancy -prevention of ovulation, for instance, which is why it works as a contraceptive. One of the other changes in pregnancy is a retention of fluid and laying down of fat as a store against the time when breast milk has to be manufactured. The pill normally produces only the earliest changes occurring in pregnancy but these vary in degree in different women. Some put on hardly any weight but others do gain a few kilos. Expert medical guidance and balanced nutrient meals can help solve your weight problem.

I have been unable to lose weight after my pregnancy. Why?
It is not at all uncommon to hear of young women who have always had slim, trim figures suddenly losing their cherished slimness after pregnancy. There are various causes for this phenomenon. A detailed history-taking and medical examination by doctor, could reveal the underlying cause. Take the case of Mrs. N.M. a twenty-six-year-old mother.

Like many young mothers, she had an ideal figure prior to her first pregnancy, but soon after she began to gain weight steadily during her pregnancy and continued to do so after her delivery. At the time examined her she was twenty-one kilos overweight.

Mrs. N.M. complained of breathlessness on exertion, such as climbing stairs. Her swollen feet were causing her considerable discomfort. During this time, she had developed arthritis of the knees and lower back. Of course these symptoms -common in case of obesity - were greatly aggravated by her excessive body weight.

After a thorough physical examination and laboratory tests, it was shown that she was absolutely normal. A detailed history-taking revealed that during her pregnancy she suffered from severe hunger pangs. This coupled with the idea that a pregnant woman has to eat for two-herself and the baby-had led to "pampering" by the husband and the parents, resulting in overindulgence in foods least required by her, to meet the nutritional demands of pregnancy. She had even gained extra weight while nursing her baby. She was made to realize that this increase in weight, in time, could lead to subtle changes in body chemistry making it more and more difficult to shed weight and that what actually is required was a qualitative increase in food intake, under medical guidance, during pregnancy and nursing and not quantitative increase based on medical ignorance, wrong concepts and the false notion that she has to eat rich foods.

After ten months of treatment for her arthritic pain and obesity and a guide to sensible, nutritionally oriented eating, the patient achieved her ideal weight, regained her trim figure, and was no longer plagued by swollen feet, difficulty in breathing, or arthritic symptoms. For the past two-and-a-half years, she has maintained her weight and has been freed of her former symptoms.

I am three months pregnant and so far I don’t have any stretch marks. A friend told me she used a special liniment when she was pregnant and she got very few stretch marks. Is this worth trying?
It is very unlikely indeed that any cream or liniment can actually prevent stretch marks, although there are a number of myths about such substances. Oil or cream rubbed into the skin of your breasts and abdomen can help with any dry or flaky skin, but it won’t stop the stretch marks. Ignore people who give you unprofessional advice. Consult your gynaecologist about correct and balanced eating to maintain right weight. Rapid and excess weight gain, usually during pregnancy, is often the main cause of stretch marks.

My mother-in-law says that my abdomen has bulged since my gynaecologist did not tie a wrap around it soon after my delivery. Is it true?
No. What your mother-in-law is not true. The practice of tying a wrap around the abdomen soon after delivery has a scientific reason.
After the 4th month of pregnancy, the uterus containing the baby, rises into the abdomen from the pelvic position. IN doing so the uterus gradually pushes the intestines behind it. By full term, 34-to-36 weeks of pregnancy, the intestine lie more or less completely behind the uterus in the abdominal cavity. At the same time the abdominal wall in front, is also stretched to accommodate the enlarged uterus. It is also common, not necessary, of course, for a woman to put on excess weight (fat) during pregnancy apart from the weight of the baby.

When the delivery occurs and if the woman has a lax abdominal wall due to excess weight, the intestine which suddenly gush forward to occupy the now empty abdominal cavity also push the toneless abdominal wall further out making the woman uneasy and bloated with a sense of abdominal heaviness and fullness all the time. In order to prevent these symptoms the gynaecologist has to tie a wrap to support the abdomen of an abese woman with a toneless abdominal wall following delivery.

Modern day gynaecologists warn their pregnant patients from putting on excess weight for fear of the above, plus other far more serious consequences of obesity and pregnancy.

They advise the patient pre-natal exercises to keep the abdominal and pelvic muscles toned to facilitate delivery and prevent symptoms such as seen above following delivery. They also advise post-natal exercises to keep the body trim and firm.

So you see, your mother-in-law is wrong. It is not the failure to tie a wrap around the abdomen after delivery, on the part of the gynaecologist, that has caused your abdomen to bulge. In fact, it is your bulged abdomen, resulting from excess weight (fat) put on during pregnancy that compels a gynaecologist to tie a wrap around it, following delivery.

I lose weight for a while and then seem to hit a plateau. Could it be my glands?
Anyone who has dieted frequently has experienced the "weight plateau". This is a condition where one loses weight regularly for several weeks or months and then suddenly the weight loss stops and one remains at the same weight inspite of continuing to diet. In most cases, this is a temporary phenomenon. S.B. was thirty-three-years-old and had gained twenty-two kilos over three years following her pregnancy. During a five-month period prior to being seen by me, she had faithfully remained on her physician’s diet and had lost twelve kilos, but had been unable to lose any more than that. After the twelve kilo loss, she was still ten kilos over her ideal weight, and had remained at this plateau for three months. A detailed record of her food habits was noted and a slightly modified nutritionally balanced food programme was recommended to her along with her treatment for obesity. Within four months, she had lost the excess ten kilos.

Once in a while, the weight plateau stubbornly persists, and when this occurs, it is necessary to determine the cause of the persistent plateau. Researches today increasingly accept the relatively new theory that body "defends" a certain weight at certain times. These weight plateaux are often referred to as set points or setting points. Most experts believe that set points are the result of a number of cultural and hereditary factors.

What are these cultural factors that influence obesity?
Cultural influences play a significant role in fixing an individual’s weight. North Indians or Keralites who have a low rate of obesity in their native land become progressively heavier as they move towards the metropolis like Bombay. The blame could be put on the eating habits. The kind of food they eat, high in fat and sugar and low in nutrients and fibre could predispose people to obesity.

Food in major cities in abundantly available at all hours in round the clock restaurants, fast-food joints, take away and home delivery. Moreover an average Indian refrigerator is bulging with food and this habit to eat from the refrigerator at all times of the day adds to the problem of obesity.

Eating in front of the television is also to be blamed.

How common is glandular obesity?Hormonal obesity is rare. I want to repeat that the role of hormones in obesity has been overemphasized for years. More than ninety-five percent of the Indians who are obese have healthy, well-functioning hormonal glands. So if you obese it is almost certainly inspite of, not because of your glands.